Individual
GRACE KUTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5408 NE 29TH AVE, PORTLAND, OR 97211-6244
(503) 686-1786
Mailing address
5408 NE 29TH AVE, PORTLAND, OR 97211-6244
(503) 686-1786
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/10/2021
Last updated
08/04/2022
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